Office-based anesthesia: Guidelines

The ASA has produced a set of guidelines regarding the delivery of office-based anesthesia and the special considerations this brings. It defines the expected medical leadership roles of the practice and the need for compliance with building standards laid out by state and federal bodies.

Regarding clinical care, the document states that the patient (given their state of health) and the procedure should be appropriate for the setting and should permit discharge from the facility. It states that the usual preoperative assessment, intraoperative monitoring and post-operative care standards apply. That the anesthesiologist should document the decision to discharge the patient and must be physically present until the patient has been discharged from anesthesia care and persons with advanced resuscitation training should be present until the patient is discharged home.

The document describes the necessity of reliable source of oxygen, suction, resuscitation equipment and emergency drugs. Appropriate space to ensure all equipment and personnel can work effectively and access patient in case of an emergency. Equipment should be tested, maintained and inspected and logs maintained. Backup power “sufficient to ensure patient protection in the event of an emergency” should be available. Equipment appropriate to infants and children should be available, if they are to be anesthetized in this location.

Finally the document discusses emergencies and needs for transfer to another facility. It specifies the need for training of all personnel in case of emergency. It specifies that written protocols should exists for treatment of cardiopulmonary emergencies and other physical emergencies such as fire. Medications, equipment and written protocols should be available for the treatment of Malignant Hyperthermia where triggering agents are used. Written protocol should exist for the timely transfer of patients to a designated alternate facility when “extended or alternate services” are needed.